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192746 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 00350980 Page 1 of 1 ONE CIVIC SQUARE VERIZON WIRELESS CARMEL, INDIANA 46032 P. 0. Box 25505 CHECK AMOUNT: $2,757.52 LEHIGH VALLEY PA 18002 -5505 CHECK NUMBER: 192746 CHECK DATE: 12/15/2010 DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4344100 2492559044 34.53 485296750 -00001 1160 4344100 2493087997 421.09 580874429 -00001 209 4344100 2495245933 192.94 380784826 -00001 1115 4344100 2495251273 686.26 680779358 -00001 1192 4344100 2495252997 1,057.42 780779357 -00001 1401 4344100 2496795529 365.28 480888597 -00001 V,�-''veriZo 1 wireless 777 BIG TIMBER ROAD Manage Your Account &View Your Usage Details Account Number 1 Date Due ELGIN, IL 60123 Invoice Number 1 2495251273 Quick Bill Summary Oct 29 Nov 28 30000094 06 SP 1.730 "SNGLP T2 1 4728 46032- 171531 1 E MICH2810 I ll a 1�1�1111��1 a ll���1111111�1 a 1II��IIII�I�I�II�111III n i�� CITY OF CARMEL IN Previous Balance (see back for details) $2,139.35 CARMEL CLAY COMMUNICATIONS 31 1 STAVE NW Payment —Thank You $1,397.03 JANET ARNONE Balance Forward Due Immediately $742.32 CARMEL, IN 46032 -1715 Monthly Access Charges $662.55 Usage Charges Voice $.00 Messaging $.25 Data $.00 Verizon Wireless' Surcharges and Other Charges Credits $23.46 Taxes, Governmental Surcharges Fees $.00 Total Current Charges Due by December 23, 2010 $686.26 Total Amount Due $1,428.58 Pay from wireless Pay on the Web Questions: #PMT (#768) At vzvv.corn/r*usinessaccount 1.800.922.0204 *611 from your wireless \.,�verizo0P1, wireless Invoice Number Account Number Date Due Page Get Minutes Used Get Data Used Get Balance 1 1A 1 #BAL 1 Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $2 ,139.35 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray P ayment Received 11/01/10 1,397.03 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Total Payments $1,397.03 Service Charge (and, it applicable, a State Universal Service Balance Forward Due Immediately $742.32 Charge) to recover costs imposed on us by the government to support universal service, and may include other charges also related to our governmental costs. It also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of $5 or 1.5% per month, or as permitted by law. Verizon Wireless' Other Charges and Credits Includes charges for products and services, and credits owing. "G'f &`:s vk'�`� �-�f �yz. �..�5;� ^j,'��.t��"„tf ,�,',�t F .:..,t 3' ``W'"'�v#'�??. r�'„xa�r� t.: r r^- �oeresporr�dence Kdtiress ,Verizon Wireless 0pera�toits,Su�por3 8�xa�8� �3�:p,y Prescribed by Stale Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/28/10 I 2495251273 I $686.26 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Verizon Wireless IN SUM OF P.O. Box 25505 Lehigh Valley, PA 18002 -5506 $686.26 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. I ACCT #ITITLE AMOUNT Board Members 1115 I 2495251273 I 43- 441.00 I $686.26 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thursday, December 09, 2010 Dire ctor Title Cost distribution ledger classification if claim paid motor vehicle highway fund V,- mnMrelew 777 BIG TIMBER ROAD Manage Your Account &View Your Usage Details Account Number Date Due ELGIN, IL 60123 Invoice Number 1 2495252997 Quick Bill Summary Oct 29 Nov 28 40000058 06 SP 1.730 "SNGLP T2 2 4728 46032- 258401 1 E MICH2810 CITY OF CARMEL Previous Balance (see back for details) $2,191.20 DOGS Payment Thank You $1,003.07 1 CIVIC SQ CARMEL, IN 46032 -2584 Balance Forward Due Immediately $1,188.13 Monthly Access Charges $1,019.78 Usage Charges Voice $.00 Messaging $4.26 Data $.00 Verizon Wireless' Surcharges and Other Charges Credits $33.38 Taxes, Governmental Surcharges Fees $:00 Total Current Charges Due by December 23, 2010 $1,057.42 Total Amount Due 4 F ��FO o OC Pay from Wireless Pay on the web Questions: 1 or *611 f rom your wireless 1 /verizo wireless Invoice Number Account Number Date Due Page w� 2495252997 780779357 00001 PastDue 2 of�47 r, Get Minutes Used Get Data Used Get Balance SEND #BAL+ SEND Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $2,191.20 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray P ayment Received 11/01/10 1,003.07 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Total Payments $1,003.07 Service Charge (and, it applicable, a State Universal Service Balance Forward Due Immediately $1 188.13 Charge) to recover costs imposed on us by the government to support universal service, and may include other charges also related to our governmental costs. It also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of $5 or 1.5% per month, or as permitted by law. Verizon Wireless' Other Charges and Credits Includes charges for products and services, and credits owing. Corres ondence Address: Verizon Wireless 0 erattons Su ort P 0 Box 9058 DubIi 0 43017 'i VOUCHER NO. WARRANT NO. ALLOWED 20 Verizon IN SUM OF P.O. Box 25505 Leigh Valley, PA 18002 -5505 $1,057.42 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1192 2495252997 43- 441.00 $1,057.42 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Monday, Decgmber 13, 2010 r Director, DO Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/10/10 2495252997 Monthly charges $1,057.42 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer VEYi Mpwireless 777 BIG TIMBER ROAD Manage Your Account View Your Usage Details Account Number Date Due ELGIN, IL 60123 485296750-00001 Invoice Number 12492559044 w 10000139 01 AV 0.335 "AUTO T1 3 4722 46032 258402 1 E MICH2210 Quick Bill Summary Oct 23 Nov 22 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 'lllllllllll llllllllllllllll CARMEL FIRE DEPARTMENT 2 CIVIC SQ Previous Balance (see back for details) $91.61 CARMEL, IN 46032 -2584 Pa Thank You $91.61 Balance Forward $.00 Monthly Access Charges $32.39 Usage Charges Voice $.00 Messaging $58 Verizon Wireless' Surcharges and Other Charges Credits $1.56 Taxes, Governmental Surcharges Fees $.00 Total Current Charges $34.53 Total Charges Due by December 17, 2010 $34.53 Pay from Wireless Pay on the Web Questions: 1.800.922.0204 or '611 from your wireless \,--�ved nw ireless Invoice Number Account Number Date Due Page Get Minutes Used Get Data Used Get Balance sA Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $91.61 Verzon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payments Thank You imposed on us, including a Regulatory Charge (which helps defray Pay Received 11/01/10 —57.51 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Payment Received 11/16/10 —34.10 Service Charge (and, it applicable, a State Universal Service Total Payments $91.61 Charge) to recover costs imposed on us by the government to support universal service, and may include other charges also Balance Forward related to our governmental costs. 11 also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A fate payment applies for unpaid balances. The charge is the greater of S5 or 1.5% per month, or as permitted by law. Verizon Wireless' Other Charges and Credits Includes charges for products and services, and credits owing. t;'u$ ,ry g am'" o podenc Address: Operations Support P 0 Box 9058DubinOH43017 a L 'c VOUCHER NO. WARRANT NO. ALLOWED 20 Verizon Wireless C IN SUM OF P.O. Box 25505 Lehigh Valley, PA 18002 $34.53 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 2492559044 43- 441.00 $34.53 1 hereby certify that the attached invoice(s) or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except DEC 1 3 n 6 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2492559044 $34.53 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer �V wireless 777 r 777 BIG TIMBER ROAD Manage Your Account View Your Usage Details Account Number l Date Due ELGIN, IL 60123 3 807 848 0000 1 Invoice Number 1 2495245933 1 20000275 02 AT 0.482 "AUTO T3 0 4728 480 258401 1 r MICH2810 Quick Bill Summaiy Oct 29 Nov 28 11 l 11 l 1 11 11 11 11111 11 III I I I II 11 l 1 l 1 l 1 l II l ll lilll 111E111 kill CITY OF CARMEL IN CARMEL LEGAL DEPT Previous Balance (see back for details) $365.67 1 CIVIC SQ Payment Thank You $173.41 CARMEL, IN 46032 -2584 Balance Forward Due Immediately $192.26 Monthly Access Charges $186.96 Usage Charges Voice $.00 Messaging $15 Data $.00 Verizon Wireless' Surcharges and Other Charges Credits $5.23 Taxes, Governmental Surcharges &Fees $.00 Total Current Charges Due by December 23, 2010 $192.94 Total Amount Due $385.20 Pay from Wireless Pay on the Web I Questions: o 1 800 .922.0204 or *611 f rom your wireless �V(0J z_0nwlreless Invoice Number Account Number Date Due Page ,R� b F 2495245933 A a�38Q784826 OOOU1Past�Due ��2 of�1�4 Get Minutes Used Get Data Used Get Balance Ogg Amoffla p M O NO Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $365 .67 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray pay Received 11101!10 173.41 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Total Payments $173.41 Service Charge (and, if applicable, a State Universal Service Balance Forward Due Immediate) 192.26 Charge) to recover costs imposed on us by the government 10 y support universal service, and may include other charges also related to our governmental costs. It also includes an Administrative Charge, which helps defray certain costs we _incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to lime. Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of $5 or 1.5% per month, or as permitted by law. Verizon Wireless' other Charges and Credits Includes charges for products and services, and credits owing. "Cowes oodence� ddress: Verrzo��Wlreless�0�eratrnns Su ort,P.Ci. -Box 9058Dublrn,OF1- 4301,7 �.n Prescribed by State Board of Accounts City Form No. 261 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee VERIZON WIRELESS Purchase Order No. P. O. Box 25505 Terms Lehigh Valley, PA 18002 -5505 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12 -9 -14 2495245933 Cellular phone fees per the attached invoice $192.94 Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Verizon Wireless IN SUM OF P. O. Box 2550 Lehigh Valley, PA 18002 -5505 $192.94 ON ACCOUNT OF APPROPRIATION FOR DEFERRAL FEE FUND 209 430 -44100 Cellular Phone Fees Board Members p 'S INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or 209 2495245933 $192.94 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except kgu 9 20/0 Signatur Cost distribution ledger classification if T ye claim paid motor vehicle highway fund f verizoAwireless 777 BIG TIMBER ROAD Manage Your Account &View Your Usage Details Account Number Date Due ELGIN, IL 60123 0 0 0 :0: fill 9 Invoice Number 1 2493087997 20001564 03 AB 0.610 "AUTO T2 0 4723 46032- 258401 1 EMICH2310 Quick Bill Summary Oct 24 —Nov 23 CITY OF CARMEL IN JENNY CHASTAIN Previous Balance (see back for details) $922.66 CIVIC SQ CARMEL, IN 46032 -2584 Payment Thank You $449.23 Balance Forward Due Immediately $473.43 Monthly Access Charges $427.87 Usage Charges Voice $5.00 Messaging $14.25 Data $1.99 Verizon Wireless' Surcharges and Other Charges Credits $8.62 Taxes, Governmental Surcharges Fees $.00 Total Current Charges Due by December 18, 2010 $457.73 Total Amount Due $931.16 Pay from Wireless Pay on the Web Questions: rn/mv bu sines saccoun t 1.800.922:0204,or ver►ynwireless Invoice Number Account Number Date Due Page Get Minutes Used Get Data Used Get Balance ME *me MOM Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $922.66 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray P ayment Received 11/16/10 449.23 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Total Payments $449.23 Service Charge (and, if applicable, a State Universal Service Balance Forward Due Immediately $473.43 Charge) to recover costs imposed on us by the government to support universal service, and may include other charges also related to our governmental costs. It also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) tees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of $5 or 1.5% per month, or as permitted by law. Verizon Wireless' Other Charges and Credits Includes charges for products and services, and credits owing. a" cr a r Cor.res ondence'Aiidress Venzon Wtretess 0 eratrons Su ort''f �Q "Box 9058 Dublin OH 43017 11 VOUC N O. WARRANT NO. ALLOWED 20 Verizon Wireless IN SUM OF P. O. Box 25505 Lehigh Valley, PA 18002 -5505 $421.09 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1160 2493087997 43- 441.00 $421.09 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Friday, December 10, 2010 Mayor Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/23/10 2493087997 $421.09 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer `�VePiZoRlwireiess 777 BIG TIMBER ROAD Manage Your Account &View Your Usage Details Account Number 1 Date Due ELGIN, IL 60123 At vzw 480888597-0000 Invoice Number 12496795529 20000063 03 AT 0.607 "AUTO T1 0 4803 46032 258401 1 E MICH0310 Quick Bill Summary Nov 04 Dec 03 CITY OF CARMEL CITY COUNC 1 CIVIC SQ Previous Balance (see back for details) $364.50 CARMEL, IN 46032 -2584 Payment Thank You $364.50 Balance Forward $.00 Monthly Access Charges $353.83 Usage Charges Voice $.00 Messaging $3.97 Data $.00 Verizon Wireless' Surcharges and Other Charges Credits $7.48 Taxes, Governmental Surcharges Fees $.00 Total Current Charges $365.28 Total Charges Due by December 29, 2010 $365.28 Pay from Wireless Pay on the web Questions: #PMT (#768) At vzW.com/m,ybbsinessaccount 1 or *611 f rom,your wireless \-Ver6 Invoice Number Account Number Date Due Page y a Lae r a. g'm— +—rrr3„ a' a as S ,4. y U'� r, -.,�i k t v y $v Get Minutes Used TGet Data Used Get Balance Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $364.50 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray P ayment Received 11129/10 364.50 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Total Payments $364.50 Service Charge (and, if applicable, a State Universal Service Balance Forward Charge) to recover costs imposed on us by the government to support universal service, and may include other charges also related to our governmental costs. It also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of $5 or 1.5% per month, or as permitted by law. Verizon Wireless' Other Charges and Credits includes charges for products and services, and credits owing. h NE Correspondence Address: Verizo`"n Wrreless:Qpe atronsrFS pu po t'P 0 8ox,,9058 D bl r O 0 7 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units,' price per unit, etc. I Payee c Purchase Order No. Terms Date Due [I Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 g�D�lrl1) l�'� Vy��' -U! S� IN SUM OF To 8c) T Zq)6 ON ACCOUNT OF APPROPRIATION FOR c _v Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 20 Signaturr7 Cost distribution ledger classification if Title t t claim paid motor vehicle highway fund